Study Guide - Midterm.docx

Mental Health Course Midterm: 50 questions, 82 seconds per question Chapters: 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 16 (partial chapter 16 – depression) March 2024 STUDY GUIDE Directions: Please use this as a guide to help you study and prepare for the mental health nursing mid-term exam. Be able to an...

Mental Health Course Midterm: 50 questions, 82 seconds per question Chapters: 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 16 (partial chapter 16 – depression) March 2024 STUDY GUIDE Directions: Please use this as a guide to help you study and prepare for the mental health nursing mid-term exam. Be able to answer questions related to the following topics. Know levels of anxiety: mild, moderate, severe, panic Mild- patient is able to adapt to stressors, seldom a problem. It prepares people for action, sharpens the senses, increases productivity, increases the perceptual field, and heightens awareness of the environment. The individual is able to function at an optimal level. Moderate- perceptual field begins to diminish., the individual becomes less aware of events occurring in the environment, attention span and the ability to concentrate decreases, may require assistance with problem solving, Increased muscular tension and restlessness. Severe- Perceptual field diminishes greatly. Concentration centers on one detail only or many erroneous details, attention span is limited, and has difficulty completing the simplest task. Panic- The most intense state, the individual is not able to perform the simplest task or concentrate on small details. Characterized by hallucinations and delusions. Understand purpose of defense mechanisms- at the mild level, individuals employ various coping mechanisms to deal with stress. A few of these include (eating, drinking, sleeping, physical exercise) Coping skills are coping behaviors that enhance one’s adaptations. At the mild to moderate level, the strength of the ego is tested. Ego defense mechanisms to Know examples of defense mechanisms – reaction formation, projection, sublimation, displacement, denial Reaction formation- client hides her negative reactions through an exaggerated expression of positive feelings. Projection- a person attributes their own thoughts and feelings onto someone else who may not have the same thoughts and feelings. Sublimation- transforming one’s anxiety or emotions into pursuits considered by societal or cultural norms to be more useful. (a person channels their aggression and energy into playing sports.) Displacement- transferring feelings or emotions from one target to another ( a patient given a poor prognosis takes it out on their nurse by yelling at them) Denial- stage of disbelief in which the reality of loss is not acknowledged. When is a patient at risk for developing a mental health disorder – know maladaptive versus adaptive Adaptive- successful adaptation to stress from internal and external environment, evidence by thoughts feelings and behaviors that are age appropriate and congruent with local and cultural norms. Maladaptive- maladaptive responses to stress from internal and external environment, evidenced by thoughts, feelings and behavior that are incongruent to local and cultural norms and interfere with a person’s social, occupational and/ or physical health. Know Maslow’s hierarchy of needs and the levels associated with mental health A hierarchy of needs>>> self-actualization as one’s highest potential. Physiological needs- (air, water, food, shelter, clothing, sleep, reproduction) Safety needs>>> (personal security, resources, employment, health, property) Love and belonging >>> (friendship, intimacy, sense of belonging, connection) Esteem>>> (respect, self-esteem, status, recognition, strength, freedom) Self-actualization>>> (desire to become the most that one can be) Malow believed self-actualization people possess: An appropriate perception of reality The ability to accept oneself, others, and human nature. The ability to manifest spontaneity. The capacity to focus concentration on problem-solving A need for detachment and a desire for privacy Independence, autonomy, and resistance to enculturation An intensity of emotional reaction Creativity and an identification with humankind. Purpose of taking medical assessment of the patient when treating the patient for psychiatric conditions, i.e., why assess medical conditions, medications, etc. when treating depression, etc. Psychosis – what is it? Do patients know when they are psychotic? Psychosis- extended periods of functioning at the panic level of anxiety. Eg of psychotic disorder = schizophrenia, schizoaffective disorder, and delusional disorder. Individuals may experience delusions, hallucinations, disorganized speech and catatonic behavior. Common characteristics of psychoses: They exhibit minimal distress. They are unaware that their behavior is maladaptive. They are unaware of any psychological problems. They are exhibiting a flight from reality into a less stressful world or into one which they are attempting to adapt. Neurotransmitter associated with schizophrenia diagnosis Norepinephrine, dopamine, serotonin Neurotransmitter associated with fight-or-flight response >> Norepinephrine Understand difference between parasympathetic and sympathetic nervous system, and how it relates to fight or flight responses Sympathetic nervous system- dominant in stressful situations and prepares the body for fight or flight>> results in increased heartrate and respirations, blood is shunted to the vital organs and to muscles. Parasympathetic nervous system- dominant in relaxed situations>>> p romotes elimination functions. Know the name of the emotional center of brain Limbic system >>> includes the thalamus and hypothalamus and other minor structures called the emotional part of the brain. Know part of brain responsible: (a) emotion>> limbic system (frontal lobe plays a role in emotional experiences and temporal lobe plays a role in expression of emotions) (b) executive functioning>>> prefrontal cortex (c) vision>>> occipital lobes (primary area of visual reception and interpretation) (d) auditory>>>temporal lobes (manage auditory functions and smell). Mesencephalon responsible for integration of visual auditory and righting reflexes. Give examples of autonomy, veracity, justice, beneficence Autonomy is the right of people to determine their destinies and assumes that individuals are capable of making choices for themselves. Veracity is the principle that refers to one’s duty to always be truthful. Justice- Justice- refers to a duty the treat people fairly and equally Beneficence- refers to one’s duty to promote the good of others eg. nurses who act in the interest of their clients. Understand when a nurse can override a patient’s wishes to administer medication, i.e., patient’s right to refuse Emergency commitment- should be sorted when an individual displays behavior that is clearly dangerous to themselves and others. Involuntary outpatient commitment- court ordered process used to compel a person with mental illness to submit to an institution. Psychotropic medication classes that are associated with weight gain Lithium Know the steps forming a therapeutic relationship Rapport- implies special feelings on the part of the patient and the nurse based on acceptance, warmth, friendliness, a sense of trust and a nonjudgemental attitude. Trust- To trust another, one must feel confidence in the person’s reliability, integrity and veracity and sincere desire to provide assistance when requested. Respect-to believe in in the dignity and worth of an individual regardless of his or her unacceptable behaviour. Genuineness- refers to the ability to be open, honest and real in interactions with the patient. Empathy- the ability to see beyond outward behaviour and to understand the situation from the patients point of view. Know the priority nursing actions during each phase of the nurse-client relationship Pre-interaction phase- Preparation for the first meeting with the patient; information is gathered from charts, significant others, or other health team members. Examine one’s fears and anxieties about working with a particular patient. Orientation phase- the nurse and the patient become acquainted. Tasks during this phase include. Creating an environment of trust and rapport Establish a contract of intervention that details the expectations and responsibilities of both parties. Gather assessment data. Identify the patient’s strengths and limitations. Formulating nursing diagnoses Set mutually agreeable goals. Develop a realistic plan of action. Explore feelings of both patient and nurse Working phase is when the therapeutic work of the relationship takes place, and may include: Maintaining trust and report Promote patient’s insight and perception of reality. Use problem-solving model to work toward achievement of established goals. Overcome resistance behaviors on the part of the patient Continuously evaluate progress toward goal attainment. Transference occurs when the patient unconsciously displaces or transfers to the nurse feelings formed toward a person from the past. Transference can interfere with the therapeutic relationship when the feelings expressed include hunger and hostility. Anger toward the nurse is expressed as uncooperativeness and resistance to therapy. Transference can also take the form of overwhelming affection for the nurse or excessive dependence on the nurse. Countertransference- refers to the nurse's behavioural and emotional response to the patient. These feelings may be unresolved feelings related to a significant person from the nurse's past, or they may be generated in response to the transference feelings on the part of the patient. Termination phase is the end of nurse to patient relationship may occur for a variety of reasons: The mutually agreed on goals may have been reached. The patient may be discharged from the hospital. Or in the case of a student nurse, it may be the end of clinical rotation Understand what needs to be included in the assessments of patients with psychiatric problems Functions exclusive to the Advanced Practice Psychiatric Nurse versus Registered Nurse (and other members of the interdisciplinary team/their roles) Be able to describe various problem-oriented charting and focus charting methods Focus charting -has a list of problems as its basis, Main perspective is to choose a “focus” for documentation. The focus cannot be a medical diagnosis. Focus charting uses a data, action, and response format. D = Data: Information that supports the stated focus or describes pertinent observations about the client A = Action: Immediate or future nursing actions that address the focus, and evaluation of the present care plan along with any changes required R = Response: Description of the client’s responses to any part of the medical or nursing care Problem-oriented recording - Has a list of problems as its basis Uses subjective, objective, assessment, plan, intervention, and evaluation format. (SOAPIE) Know how to assess “orientation” – what questions would you ask? Be able to give examples of how a nurse can promote patient self-reliance Know various leadership styles and identify them Autocratic- Focus is on the leader, on whom the members are dependent for problem-solving, decision making, and permission to perform. Production is high, but morale is low. Democratic- Focus is on members, who are encouraged to participate fully in problem-solving of group issues, including taking action to effect change. Production is somewhat lower than with autocratic leadership, but morale is much higher. Lassiez Faire- There is no focus in this type of leadership. Goals are undefined, and members do as they please. Productivity and morale are low. What are Yalom’s therapeutic factors – be able to give examples Instillation of hope: By observing the progress of others in the group with similar problems, a group member garners hope that his or her problems can also be resolved. Universality: Individuals come to realize that they are not alone in the problems, thoughts, and feelings they are experiencing. Imparting of information: group members share their knowledge with each other. Leader of teaching groups also provide information to group members. Altruism: individuals provide assistance and support to each other, thereby helping to create a positive self-image and promote self-growth. Corrective recapitulation of the primary family group: Group members are able to re-experience early family conflicts that remain unresolved. Development of socializing techniques: Through interaction with, and feedback from, other members of the group, individuals are able to correct maladaptive social behaviors and learn and develop new social skills. Imitative behavior: Group members who have mastered a particular psychosocial skill or developmental task serve as valuable role models for others. Interpersonal learning: Group offers varied opportunities for interacting with other people. Group cohesiveness: Members develop a sense of belonging rather than separating the individual (“I am”) from group (“we are”). Catharsis: Within the group, members are able to express both positive and negative feelings. Existential factors: The group is able to assist individual members to take direction of their own lives and to accept responsibility for the quality of their existence. Know what to ask when assessing for suicide potential Purpose of debriefing session with clients after a stressful event on the unit Physical signs of a patient becoming angry and aggressive Basic concept of the recovery model- is empowerment of the consumer (The recovery model is designed to allow consumers primary control over decisions about their own care) Dimensions of recovery associated with SAMHSA Health- overcoming or managing one’s disease as well as living healthy in a physically and emotionally way. Home- stable and safe place to live Purpose-meaningful daily activities such as job, school, volunteerism, family caregiving or creative endeavors and the independence, income and resources to participate in society. Community-relationships and social networks theta provide support, friendship, love and hope. Nursing priority when managing a suicidal patient Priority intervention when treating a patient with command hallucinations Risk factors for committing suicide Marital status- the suicide rate for single persons is twice that of married persons. Gender- women attempt suicide more often but men succeed more, men commonly choose more lethal methods than do women. Age- risk of suicide increases with age, particularly among men. Religion- Catholics have lower rates than protestants or Jewish people. Socioeconomic status- individuals in the very highest and lowest classes have higher suicide rates than those in middle class. Ethnicity- whites are at the highest risk for suicide, followed by native Americans, African Americans, Hispanic Americans, and Asian Americans. Psychiatric illness- mood and substance use disorders are the most common psychiatric illness that precede suicide (others include schizophrenia, personality and anxiety disorders) Use of alcohol and barbiturates Psychosis with command hallucinations Affliction with a chronic, painful, or disabling illness Family history of suicide LGBT individuals have a higher risk of suicide than do their heterosexual counterparts. Having attempted suicide previously increases the risk of a subsequent attempt. About half of those who ultimately commit suicide have a history of a previous attempt. Loss of a loved one through death or separation Bullying Classification of suicide Egoistic suicide- is the response of the individual who feels separate and apart from the mainstream of society. Integration is lacking and the individual does not feel apart of any cohesive group (such as family or a church). Altruistic suicide- is the opposite of egoistic suicide. The individual who is prone to altruistic suicide is excessively integrated into the group. The group is often governed by cultural, religious, or political ties, and allegiance is so strong that the individual will sacrifice his or her life for the group. Anomic suicide - occurs in response to changes that occur in an individuals life that disrupts the feelings of relatedness to a group. An interruption in the customary norms of behavior instills feelings of “separateness,” and fears of being without support from the formerly cohesive group. Priority assessment questions when caring for patient with depression Is there a history of depressive disorder in the family, and has a close relative committed suicide in the past. Percentage of people who kill themselves AND have a prior suicide attempt. Successful suicides number about 70% for men and 30% for women. Transgender individuals are also a high-risk population for suicide with an alarming 41% lifetime prevalence. The elderly make up just over 13% of the population but account for almost t 15% of all suicides. More than 90% of people who kill themselves have a diagnosable mental disorder, most commonly a mood disorder or a substance abuse disorder. Individuals who have been hospitalized for a psychiatric illness have a 5 to 10 times greater suicide risk than others with a psychiatric illness in the general population. Religion and risk of suicide- Affiliation with a religious group decreases the risk of suicide. Catholics have lower rates than do protestants or Jewish people. Know importance of asking direct questions with suicidal patient Ethnic group and highest risk of suicide In general. 70% of all suicides are among white males, but white males over the age of 80 are at the greatest risk of all age/ gender/ race groups.